A Guide to De vel oping Materials on HIV/AIDS and STIs A Guide to De vel oping Materials on HIV/AIDS and STIs December 2003 About the STI/HIV Prevention (SHIP) Project in Georgia The goal of the SHIP Project is to reduce the rate of transmission of sexually transmitted infections (STIs) including HIV in targeted urban locations in Georgia (Tbilisi and Batumi). Save the Children and Program for Appropriate Technology in Health (PATH) are partners together with two local nongovernmental organizations (NGOs), Bemoni Public Union and Tanadgoma Center for Information and Counseling on Reproductive Health. For information about the SHIP Project, see www.assistancegeorgia.org.ge. PATH is an international, nonprofi t, NGO whose mission is to fi nd and implement solutions to critical health problems, especially those affecting women and children. PATH is widely recognized for its collaborative work with local and international partners and its success in building and sustaining public- and private-sector partnerships. PATH shares knowledge, skills, and technologies with governments and nongovernmental partners in low-resource settings around the world. For PATH, “appropriate” technologies and interventions are those that meet critical health needs in an affordable and culturally acceptable manner. PATH is based in Seattle, Washington, and has 21 program offi ces in 14 countries. Save the Children is a leading international nonprofi t children’s relief and development organization working in more than 40 countries, including the United States, to create lasting, positive change in the lives of children in need. Save the Children works with communities and local partner organizations to help establish sustainable, self-suffi cient programs in health, education and economic opportunities. Save the Children is fi ghting HIV/AIDS at the community level in several African, Asian, and Eastern European countries with programs that provide care and support for children and families affected by the disease as well as education for adults and youths on ways to prevent transmission and infection. This publication was made possible by support from the United States Agency for International Development to the STI/HIV Prevention Project in Georgia under the terms of Cooperative Agreement No. 114-A-00-02-00095-00. The opinions expressed are those of the authors and do not necessarily refl ect the views of USAID. A Guide to Developing Mate ri als on HIV/AIDS and STIs iii iv Acknowledgements The focus of this guide, adapted specifi cally for the Eurasia Region, is on developing educational materials for use in programs to reduce the incidence of sexually transmitted infections (STIs), including HIV/AIDS. The primary audience comprises public and private agencies and individuals working in STI and HIV prevention education in Eurasian countries. The recommended methodologies described in this guide are applicable to print materials as well as audiovisual or mass media materials for almost any population group. The Russian-language edition was adapted from several previous publications, namely, the Immunization and Child Health Materials Development Guide (PATH, 2001) and Developing Materials on HIV/AIDS and STIs for Low-Literate Audiences (FHI/PATH, 2002). Many thanks to the staff of PATH and Save the Children who contributed to the Russian- language edition and envisioned the use of the guide in Georgia by SHIP project partners: From PATH: Siri Wood, Svitlana Okromeshko, Amie Bishop, Kateryna Gamazina, Alla Kovtun, Elena Kononova, Patrick McKern From Save the Children: Silvia Gurrola, Tea Tsagareli, Tamar Tsereteli, George Begiashvili From Bemoni Public Union: Tamar Sirbiladze From Tanadgoma Center for Information and Counseling on Reproductive Health: Nino Tsereteli Any parts of this Guide may be photocopied or adapted to meet local needs without permission from Save the Children and PATH, provided that the source is acknowledged, the parts copied are distributed free or at cost (not for profi t), and credit is given to Save the Children, PATH, and Family Health International. Suggested Citation: PATH and Save the Children. A Guide to De vel op ing Materials on HIV/AIDS and STIs. Seattle: PATH and Save the Children (2003). Seattle, Washington December 2003 A Guide to Developing Mate ri als on HIV/AIDS and STIs v vi Contents Introduction 1 Step 1: Plan Your Project 5 A. Review Existing Materials and Resources 5 B. Develop a Communications Objective 6 C. Create a Workplan 8 D. Develop a Budget 8 Step 2: Identify and Study Your Audience 11 A. Audience Information Needs 11 B. Defi ne Your Audience 11 C. Study Your Audience 14 D. Qualitative and Quantitative Research 14 E. Types of Information Suggested for Audience Research 16 F. Focus Group Discussions (FGDs) 17 G. In-Depth Interviews (IDIs) 26 H. FGD and IDI Data Analysis 28 Step 3: Develop Messages 35 A. Design Messages 36 B. Develop Storyboard With Illustrations 42 C. Create Draft Text 43 D. Review Draft With Technical Team 44 E. Key Concepts for HIV/AIDS and STI Programs 44 Step 4: Create Draft Materials 47 A. Design/Layout 47 B. Illustrations 49 C. Text 51 D. Adaptation 52 E. Radio Materials 53 A Guide to Developing Mate ri als on HIV/AIDS and STIs vii F. Video Materials 53 G. Computer-Based Materials 54 Step 5: Pretest and Revise Draft Materials 63 A. Variables to Be Measured 65 B. Individual Pretests 66 C. Use of Pretesting Forms 70 D. Group Pretests 78 Step 6: Produce Materials 81 A. Printing Considerations 81 B. Alternatives to Printing 83 Step 7: Distribute Materials and Train on Their Use 85 Step 8: Evaluate Materials 87 Conclusion 89 References 91 Resources 93 Acronyms 96 Appendix A. Draft Sample FGD Guide 97 Appendix B. Forms to Use When Developing and 131 Pretesting Materials Appendix C. FGD and Pretesting Job Aids 141 Appendix D. Characteristics of Various Communication 153 Materials and Methods viii Introduction MAIN TOPICS ❑ Defi ning behavior change communication (BCC) ❑ The role of print materials in the BCC process ❑ How to use this guide I. Introduction High-risk and vulnerable populations for HIV and AIDS are often in marginalized communities (sex workers, injecting drug users [IDUs], migrant populations, youth out of school, women). They may have limited access to information and services. HIV/AIDS program planners often face the dilemma of communicating the complex issues of HIV/AIDS effectively to a specifi c population. They have successfully used drama, traditional media, and video for this purpose, and they have developed print materials with visual aids or pictures that convey vital information and stimulate discussion on issues related to risk behaviors and sex and sexuality. Much has been learned over many years about communicating messages effectively, including the use of pictorial print materials. This guide offers step-by-step guidelines for developing accurate, useful, and action- oriented educational materials to meet the communication needs of HIV/AIDS and STI prevention and care and support programs. Each chapter of this guide discusses a step in the materials development process in the context of developing a behavior change communication (BCC) strategy and program. It demonstrates the process of learning about target populations using qualitative research methodologies, developing effective messages with their input, and crafting visual messages to support the overall HIV and AIDS program. Involving target populations and stakeholders in the development process is key to ensuring high-quality, effective print and media materials. Finally, the guide outlines a process for rigorous pretesting to ensure that the information and issues are understood by the population groups that programs are trying to reach and infl uence. It is important to review the materials development process from beginning to end to understand each step and how to proceed from one phase to the next. Following the steps in sequence should result in quality educational materials to support the communication component of an HIV/AIDS program. Introduction 1 Behavior Change Communication (BCC) BCC is a process for promoting and sustaining healthy changes in behavior in individuals and communities through participatory development of appropriately tailored health messages and approaches that are conveyed through a variety of communication channels. In the context of the AIDS epidemic, BCC forms an essential component of a comprehensive program that includes prevention, services (medical, social, psychological, spiritual) and commodities (condoms, needles, and syringes, etc.). Before individuals and communities can reduce their risk or change their behaviors, they must fi rst understand the basic facts about HIV and AIDS, develop favorable attitudes toward prevention, learn a set of skills, and have access to appropriate products and services. They must also perceive their environment to be supportive of changing behaviors or maintaining safe behaviors and seeking appropriate treatment or care and support. Effective BCC can: • Increase knowledge of the basic facts of HIV/AIDS and STIs. • Stimulate community dialogue on the underlying factors that contribute to the epidemic. • Promote essential attitude changes such as perceived personal risk of HIV infection and a nonjudgmental approach on the part of health care workers. • Reduce stigma and discrimination. • Create a demand for information and services. • Advocate for policy changes. • Promote services for prevention, care, and support. • Improve skills and sense of self-effi cacy. Underlying the BCC process is the understanding that individuals and communities pass through a number of stages when learning about and adopting new behaviors. Health communication media and messages must be designed with consideration of the target population’s location on this continuum. BCC is most successful when there is an expectation of a positive 2 outcome (e.g., good health, access to services) and individuals have a sense of self-efficacy in being able to change or maintain their behavior. Figure 1 highlights this process. Unfortunately, behavior change does not always progress in a straight line as depicted.